![]() The management of AFE includes early recognition and prompt multidisciplinary management and other specialists including anesthesia, respiratory therapy, critical care, and MFM. The tissue injury and end organ system failure seen in AFE with pulmonary vascular constriction often lead to pulmonary hypertension, right-sided heart failure, and global myocardial depression. ![]() The third phase is characterized by lung injury and coagulopathy, which may include disseminated intravascular coagulation (DIC). The second phase involves decreased systemic vascular resistance and left ventricular stroke work index. The first phase involves pulmonary and systemic hypertension with resultant severe pulmonary vasoconstriction, characterized by respiratory distress and hypoxemia, leading to altered mental status followed by hemodynamic collapse. Three phases have been described during the clinical course of AFE. Labor abnormalities associated with an increased risk of AFE include precipitous labor, induction of labor, placental abruption, cervical laceration, and uterine rupture. Risk factors for AFE include advanced maternal age, multiparity, pre-eclampsia, eclampsia, diabetes mellitus, and polyhydramnios or other uterine over-distention. ![]() Patients may also present with acute severe consumptive coagulopathy without cardiorespiratory symptoms. AFE should be considered in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman. Although the pathophysiology of AFE is not known, it has been suggested that entry of amniotic fluid into the maternal circulation activates inflammatory mediators causing an anaphylactoid response.Īlthough AFE occurs most commonly during labor and delivery or the immediate postpartum period, it has been reported to occur as late as 48 hours postpartum. Neurologic impairment is also common in maternal survivors, particularly those who suffer associated cardiac arrest. Many surviving neonates suffer neurologic impairment. If AFE occurs prior to delivery, the neonatal mortality rate is estimated to be 10-50%. It is responsible for approximately 10-15% of maternal deaths in developed countries. The frequency of AFE is 2-7 cases per 100,000 births. Amniotic Fluid Embolism (AFE) is an uncommon, catastrophic obstetric emergency.
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